- Annual maximum:
$250,000
-
Co-insurance in network:
80%
- Co-insurance out-of-network:
70%
-
Deductible in network:
$500
- Deductible in non-network:
$750
- Out of pocket in network:
$5000
- Co-pay in ER (waived if admitted):
$300
- Co-pay in SHC:
$0
- Co-pay hospitalization:
$200
- Pre-existing condition waiting period:
6 months
- Medical evacuation:
$50,000
- Repatriation:
$25,000
- Rating base:
Daily
- Premium:
$57.2/Month
- Annual maximum:
Unlimited
-
Co-insurance in network:
90%
- Co-insurance out-of-network:
70%
-
Deductible in network:
$100
- Deductible in non-network:
$200
- Out of pocket in network:
$2500
- Co-pay in ER (waived if admitted):
$300
- Co-pay in SHC:
$0
- Co-pay hospitalization:
$200
- Pre-existing condition waiting period:
No Waiting
- Preventative care:
90% PA
in network or 100% UCR in SHC
- Medical evacuation:
$50,000
- Repatriation:
$25,000
- Rating base:
Daily
- Premium:
$81.2/Month